Complex Case Manager RN - Oncology (Remote)

Highmark; Pennsylvania; Remote; USD 57,000 - 108,000; Full time

Job summary

An established industry player is seeking a Complex Case Manager RN specializing in Oncology. This remote role requires a dedicated professional to manage a diverse panel of members, assessing their health needs and developing tailored care plans. You will play a crucial role in coordinating care, addressing barriers, and ensuring members achieve their health goals. With a focus on quality outcomes, you will document activities in compliance with relevant standards. If you're passionate about making a difference in patient care and possess strong communication and organizational skills, this opportunity is perfect for you.

Qualifications

• 7 years of clinical or case management experience required.
• Oncology experience preferred along with cultural competency.

Responsibilities

• Oversee a panel of members and assess their health needs.
• Create and manage care plans to improve health outcomes.
• Document all activities in compliance with standards.

Skills

Strong communication skills

Negotiation skills

Interpersonal skills

Knowledge of disease processes

Healthcare cost knowledge

Proficiency in MS Excel

Data analysis skills

Organizational skills

Time management skills

Ability to work independently

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Tools

MS Excel

Job description

Complex Case Manager RN - Oncology (Remote)

Join to apply for the Complex Case Manager RN - Oncology (Remote) role at Highmark

Complex Case Manager RN - Oncology (Remote)

5 days ago Be among the first 25 applicants

Join to apply for the Complex Case Manager RN - Oncology (Remote) role at Highmark

JOB SUMMARY

This role involves primary ownership of a specific panel of members with varying health statuses and clinical needs. The incumbent assesses health management needs, uses data and clinical judgment to identify appropriate interventions, and manages an active caseload. Responsibilities include developing care plans, encouraging behavior change, addressing barriers, coordinating care, and utilizing resources to help members achieve health goals. The role also involves monitoring and maintaining quality outcomes across clinical, financial, and functional areas.

ESSENTIAL RESPONSIBILITIES

• Oversee a panel of members, assessing their health needs and referring them to appropriate resources.
• Create and manage care plans to address members’ needs, remove barriers, and improve health outcomes.
• Achieve targeted patient outcomes, including care plan realization.
• Document all activities in compliance with relevant standards and regulations.
• Maintain knowledge of applicable CMS, state, and regulatory requirements and standards of practice.
• Perform other duties as assigned.

EDUCATION

• Required: High School Diploma/GED

Preferred: Bachelor's Degree in Nursing

EXPERIENCE

• Required: 7 years of clinical, case management, disease management, provider operations, or health insurance experience

Preferred: Oncology experience, experience with diverse populations, cultural competency

LICENSES AND CERTIFICATIONS

• Required: RN license in PA, WV, DE, or NY (others must be obtained within 6 months)

Preferred: Certification in Case Management

SKILLS

• Strong communication, negotiation, and interpersonal skills
• Broad knowledge of disease processes and healthcare costs
• Proficiency in MS Excel and data analysis
• Organizational and time management skills
• Ability to work independently and in a team environment

OTHER INFORMATION

Travel: 0-25%

Position: Office-Based

Physical Demands: Light lifting, minimal physical exertion

Pay Range: $57,700 - $107,800

Note: The description is comprehensive but could be streamlined for clarity and focus on core responsibilities and requirements.